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Urology/Stricture issues

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Question
QUESTION: Dr., I had a hypospadius repair 35 years ago (I was about 4 at the time).  I have never had a good urine stream.  About a year and a half ago I had a kidney stone stuck about two inches from the exit for about a month.  I have passed about ten stones in my life.  This is when I was diagnosed with the stricture.  I am now post five dilations and one urethrotomy.  The stricture is back.  I am thinking of doing self cath.  I also have never been able to ejaculate with any force (just oozes or I have to squeeze it out).  Will self cath help with the weak ejaculation?  Would doing self cath with an erection help, or is that not safe?  Your help is greatly appreciated.

ANSWER: Tim,
Self catheterization is not the answer here but it will not harm you it will actually dilate the stricture and relieve symptoms to a degree. I recommend a laser urethrotomy , a surgeon can go into the penile urethra and use a 532 green laser on very low power and vaporize the stricture, afterwards an option is to inject Botox into the stricture to inhibit reoccuenance. There has been mixed results with this procedure including the Botox. The laser vaporization of the stricture is certainly necessary but the Botox is a cash pay option that insurance does not pay due to FDA approval for the use of the drug for the procedure. At this point Botox is only approved for bladder frequency. You may cath in the mean time .

---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick response.  Two follow up questions.  How does the green laser procedure differ from the cold knife procedure?  And lastly, can self cath while erect cause any more "damage" than while flaccid?

Answer
Tim,
The green laser will vaporize tissue therefore its removed and the obstruction is absent, the cold knife makes 3 inscisions in the stricture coined a Mercedes like the emblem on the car. The inscisions can just grow back together and create more collegen scar tissue from myofibroblastic regeneration subsequently creating a worse stricture. Lasers have less incidents of post surgical scar tissue because the tissue becomes de-vascularized when the 532 wavelength vacuumes the red blood cells from the tissue.

Q2, No but its not a good idea because the ejaculatory duct dilates during erection and creates a diversion for the catheter and the bladder neck will not relax, this is why its so difficult to urinate with a full erection. You won't necessarily hurt the urethra but there is a potential so wait for a flaccid state to cath.  

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Thomas A Suppe RDMS CLT

Expertise

Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.

Experience

For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

Organizations
American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Publications
Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

Education/Credentials
BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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